Hematology Flashcards by Mina O

what is the difference b/w plasma & serum?

plasma - liquid part of unclotted blood; has ALL coag factors
vs.
serum - fluid remains after blood has clotted; NO coag factors

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the buffy coats consists of?

wbcs & plts

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the body/cellular water concentration is composed of (% sodium chloride) ?

0.85% sodium chloride

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what does MCV mean & what’s the formula? range?

Mean Corpuscular Vol = avg. vol of RBCs ; fL
MCV (fL) = (Hct % ÷ RBC) X 10
norm range 80-100 fL

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what does MCH mean? what’s the formula? range?

Mean corpuscular hgb = avg wt. of hgb in an indv RBC; pg unit

MCH (pg) = (Hgb ÷ RBC) X 10

norm range 26-34 pg

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what is MCHC? what’s the formula? range?

mean corpuscular hgb conctr. = avg conctr of hgb in g/dL

MCHC (g/dL) = (hgb ÷ hct) X 100

norm. range 32-37
<32 = hypochromic ; >37 = hyperchromic

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if stain is too pink, what can cause this? how can it be fixed?

too pink = buffer/stain pH low/acidic

fix by: reducing staining time, increase washing time, make thin smear

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if stain is too blue, what can cause this? how to fix?

too blue = stain/buffer pH HIGH/acidic

fix by: increasing stain time

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what is an example of a nonvital monochrome stain?

stain SPECIFIC cellular components
EX. prussian blue –> iron granules

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what is an example of supravital stain?

stains to visualize heinz bod , retics, ets

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what are 3 phases fetal hematopoiesis takes place in?

mesoblastic (yolk) phase
hepatic (liver) phase
myeloid/medullary phase

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what is the first site of fetal hematopoiesis ?

mesoblastic (yolk phase)

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what is the first cell to be produced in the yolk sac phase?

primitive nucleated erythroblast

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what hgb is primarily produced in yolk sac erythropoiesis?

embryonic hgb (Gower I, Gower II, Portland)

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which fetal erythropoiesis phase begins ~6 wks gestation & begins to prod RBCs & other WBCs, & forms hgb F

hepatic (liver) phase

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this fetal erythropoiesis begins ~5 mo of gestation w/ BM beginning to producing mostly granulocytes ?

myeloid/medullary phase

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where is the permanent site for hematopoiesis in adults?

Bone marrow

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red marrow vs yellow marrow?

red marrow - active
yellow marrow - inactive; FAT

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T/F: Red marrow decreases as we age?

TRUE

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where does hematopoiesis take place in adults (which bones)?

flat bones , pelvis, sternum

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hypo-, hyper-, normocellular?
BM < 30% cells

hypocellular

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hypo-, hyper-, normocellular?
BM >70% cells

hypercellular

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hypo-, hyper-, normocellular?
BM has few or no hematopoietic cells

aplastic

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what is the normal M;E ratio?

3:1 - 4:1

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describe the changes of nucleus, cytoplasm, etc has a cell matures

- cell size gets smaller - nucleoli disappear - Nucleus to Cytoplasm ratio DECREASES - chromatic becomes more coarse & clumped - cytoplasms becomes lighter color

name the sequence of maturation of neutrophil

1. myeloblast 2. promyelocyte 3. myelocyte 4. metamyelocyte 5. band 6. PMN

at what stage of neutrophil development do nonspecific/primary granules show up?

promyelocyte

what is the last stage of granulocyte development that is capable of cell division?

myelotcyte

which granulocyte maturation stage is being described: - kidney bean nucleus w/ indention - pink cytoplasm w/ specific/secondary granules

metamyelocyte

toxic granulation , vacoulization, dohle bodies are all signs of...?

bacterial infection

what does a left shift mean?

rise in immature cells in blood

chronic granulomatous disease

faulty NADPH oxidase enzyme --> neutrophils cant produce superoxide radicals to Kill bacteria & fungi

what disease/syndrome am I describing? - neutrophil disorder - abnormal morphology & functionally abnorm - large grey green peroxidase in granules of WBCs - recurrent infections - worthless plts --> easy bleeding/bruising - assc w. albinism

Chediak Higashi

describe pelger huet anomaly

- morphologically abnormal neutrophil but functional - autosomal dominant - hyposeg neutrophil --> "sunglasses"

describe May Hegglin anaomaly

- autosomal dominant - dohle like bod inclusion in cytoplasm - functionally normal neutrophils - assc w/ giant plts & thrombocytopenia

describe Alder- Reilly anomaly

- large azurophilic granules in all WBCs due to digested mucopolysach in lysosomes

what are 2 common monocytic disorders that lipid storage disorders?

Gaucher's Disease - def in B-glucocerebrosidase ; Gaucher cells "hairy/cotton candy consistency" Niemann Pick Disease - def. sphingomyelinase ; cells looks "foamy"

infectious mononucleosis is caused by (? virus) & affects mostly what cells?

caused by EBV infects B lymphs --> Incr in reactive lymphs

bone marrow aspirate/core is gathered from ?

posterior superior iliac crest

why would a BM examination be done?

mostly to DX unexplained cytopenias/ilness bc BM exam is very invasive it is the last thing we do. Thats why its best for Dx UNEXPLAINED conds/

BM is assesed for

M:E ratio cellularity megakaryocyte eval any iron stores differential

what type of cells predominate in chronic vs acute leukemias?

- chronic (yrs) : mature cells - acute (wks-mo) : blasts

what is the blast % for acute leukemias?

>20% blasts

how does the FAB classify leukemias

french american british (FAB) classifies bases on cell morphology & cytochem stain ; >30% blasts = acute leukemia

how does WHO classify leukemias

cellular morphology + cytochem stains + cell markers, molecular abnormalities, & clinical sx

what does the myeloperoxidase (MPO) stain detect? what does it differentiate?

MPO stain peroxidase enzyme found in granulocytes (PMNs, eos, baso) diff b/w AML vs ALL

which stain is used best to stain phospholipids & lipoproteins. Where granulocytic cells stain blue-black (pos) & diff b/w AML vs ALL?

sudan black B

which stain detects esterase & can diff monocytic leukemias from myeloid leukemias?

esterases stain

what is the Periodic Acid-Schiff (PAS) stain. what does it detect?

stain intrecell glycogen pink - erythroblasts & lymphoblasts stain pink/red - aid in ID of erythroid leukemia & ALL

what is LAP stain?

detect alkaline phosphatase enzyme in primary granules of neutrophils

what does the LAP differenetiate?

CM(myelogenous)L vs leukemoid rxn HIGH LAP score : leukemoid rxn, PV, LOW LAP score : CML, PNH

the TRAP stain is best to ID what?

hair cells --> hairy cell leukemia

what does TdT stain stand for? what does it stain ?

TdT = Terminal deoxynucleotidyl Transferase stain LYMPHOBLASTS (ALL)

what FAB classification is the leukemic phase of Burkitt lymphoma ?

FAB L3

which FAB classification of lymphoblastic leukemia is the most common childhood leukemia ?

FAB L1

what are the 2 major categories of acute leukemia?

acute myeloid leukemia (AML) acute lymphoblastic leukemia (ALL)

what cytoplasmic inclusion is characteristic of AML?

auer rods

what do Auer rods represent?

aggregates of myeloperoxidase pos granules

which stain helps differentiate monocytes?

nonspecific esterase (NSE)

vacuolated blasts + L3 morphology --> ?

Burkitt type ALL

smudge cell are common in what type of leukemia?

Chronic Lymphocytic leukemia (CLL)

Reed Sternberg cells are common in?

Hodkin lymphoma

which subtype of Hodgkin lymphoma is most commonly associated with EBV?

mixed cellularity subtype

which subtype of Hodgkin lymphoma is the most common?

nodular sclerosis

what is mycosis fungoides

- cutaneous T cell lymphoma - Sezary syndrome - CD2. CD3. CD4 POS

describe Chronic Myelogenous Leukemia (CML)

- proliferation of granulocytes - Sx: wt loss, splenomegaly, fever, etc - BM Incr M:E - Lab : mild anemia, myelocytes, few blasts, LOW LAP - PA Xosome t(9;22) POS

if LAP score is low what can be indicated?

Chronic myelogenous leukemia (CML)

what fusion gene results from t(9;22)?

BCR-ABL gene

what is the function of the BCR-ABL1 protein?

activate tyrosine kinase --> uncontrolled cell proliferation

is BCR-ABL found in all CML cases?

yes (~95%)

WBC differential pattern in CML?

Left shift w/ all stages of granulocyte maturation present

LAP score helps differentiate CML from what condition?

Leukemoid rxn

bone marrow cellulrity in CML?

hypercellular

What are the three phases of CML?

1. Chronic phase 2. Accelerated phase 3. Blast crisis

what is essential thrombocythemia (ET)?

chronic myeloproliferative neoplasm characterized by sustained thrombocytosis due to clonal megakeryocyte proliferation

what is the primary cell line affected in ET?

megakaryocytes --> plts

what is the most common mutation in ET?

JAK 2 mutation

what are the CBC/peripheral smear findings in ET?

- thrombocytosis - Incr plts (>450 X 10^9) - giant plts - leukocytosis

why can ET cause bleeding despite high platelet?

platelet dysfunction & acquired vWD

what is Polycythemia Vera (PV)

malignant hyperplasia of multipotential myeloid stem cell cause increased of ALL cell lines

which cell lines are increased in PV?

- ALL esp RBCs

what hormone normally regulate RBC production?

erythropoietin (EPO)

how is EPO affected in PV?

decreased --> negative feedback loop bod trying to stop/slow RBCs prod since PV causing INCR of proliferation of all cell lines (esp. RBCs)

what is the most common mutation that causes PV?

JAK2 mutation

what is the CBC/peripheral smear findings of PV?

- ↑Hemoglobin >20 g/dL - ↑Hematocrit >60% - ↑ RBC count - ↑ WBC ct - ↑ plt ct - DECR EPO

why does PV cause hyperviscosity if blood?

excess prod of all cell lines --> thick blood

what is common Tx for PV

therapeutic phlebotomy

what is secondary polycythemia vera

similar to primary PV but most often due to hypoxia env (high altitude)

what is the difference in Primary PV vs secondary PV?

primary: - incr RBC - incr EPO - norm WBC & plt count secondary: - incr RBC & other cell lines - DECR EPO

what is chronic idiopathic myelofibrosis?

myeloid stem cell disorder where fibrous (scar) tissue replace BM

PV can progress to what condition?

myelofibrosis of acute leukemia

what mutation is seen in chronic myelofibrosis ?

JAK 2 mutation

how is retic count affected in chronic myelofibrosis?

retic increased to compensate

hallmark RBC morph in chronic myelofibrosis ?

dacrocytes (tear drop) due to distortion while exiting fibrotic marrow

bone marrow aspiration result in chronic myelofibrosis?

dry tap due to scarring BM tissue

what compensatory process occurs due to marrow failure?

EXTRAMEDULLARY hematopoiesis --> splenomegaly & hepatomegaly

Hematology Flashcards

(97 cards)